No one knows why 6 year-old Trenton doesn’t talk or why it took so long for him to crawl and walk or why he was scared to climb a small step.

But they do know he’s adorable, loving, has a cheerful disposition and doesn’t give up.

His mother Heidi Tessmer, the therapists at Lowcountry Therapy Center, and his M.C. Riley Elementary School teachers also know that with patience and time and teaching and practice — lots of all of it — he’ll keep listening, watching, playing and learning more tasks he can do on his own.

This determined team also knows that Trenton will learn new ways to communicate, through use of symbols and pictures if not words, and accomplish fine motor skills like buttoning his shirt.

They know because they have seen his remarkable progress.

But they are also confident that he will stop making significant progress, or even start regressing, if his therapy hours are cut.

Because Trenton’s therapies are paid for by Medicaid, which is disbursed by the South Carolina Department of Health and Human Services (HHS), his treatments are threatened. The same risk of reduced services and therapies are a harsh reality for other special needs children getting Medicaid-supported therapy in Bluffton and across the state.

The families and therapists of this special group of children are voicing their concerns about cuts in hopes Gov. Nikki Haley or HHS administrators or legislators will reverse course before it’s too late.

Trenton is considered to have “global developmental delays because we don’t have a diagnosis yet,” said speech and language pathologist Jessi Dolnik, founder of the Lowcountry Therapy Center in Bluffton’s Plantation Park.

“He also has moderate bilateral hearing loss.” He wears hearing aids.

“He’s been coming here since we opened, July 7, 2010,” she said. “He’s made great progress.”

For example, his physical therapist, Jennifer Bridwell, worked a long time getting Trenton to know it was safe to make a small step up. “He was terrified to step up a curb 2 inches,” Dolnik said. It had to do with depth perception.

“Now he can walk up a flight of stairs with his mom without having to be carried by her,” she said.

Occupational therapist Kristen Lucchesi works with Trenton on things like dressing, potty training and writing his name. He throws things, often not knowing he’s doing that. “Kristen’s working on (Trenton) holding an item long enough to complete a task, things as simple as putting a ball in a bucket.”

And Trenton sees Sarah Hanson for speech therapy, which involves teaching him, through play, how to communicate by listening and making choices, such as showing what toy he does or does not want, by pointing at symbols and pictures on different devices.

Before cutbacks occurred, through an HHS formula change that took effect Friday, Trenton was receiving speech therapy twice weekly for 45 minutes each time, occupational therapy twice weekly for 45 minutes each time, and physical therapy once a week for 45 minutes — for a combined total of 3 hours, 45 minutes a week. That came to 15 hours or more a month, and 195 hours a year.

The regulation that began Friday sets a cap at 75 hours a year for the fiscal year that began last July 1, unless the child’s pediatrician states that more therapy hours are medically necessary and HSS, in turn, approves more hours.

The Medicaid coverage change is for disabled individuals 20 and younger.

A letter sent by therapists to state legislators on Jan. 13 said, “This will drastically reduce services and will negatively impact the lives of South Carolina’s most vulnerable citizens — our children with disabilities. With these Medicaid cuts, these individuals would no longer be able to receive weekly therapy sessions they so desperately need to become functional members of society. Families throughout South Carolina are under a great deal of stress because of their children’s disabilities… Our state should give support and hope to families struggling to help their children achieve the maximum potential in life,” the letter concludes.

HHS spokesman Jeff Stensland said last week that requests for more therapy hours are being reviewed and most granted, though some not for as much as sought, within about a week’s time turnaround.

“The 75 hour limit was never meant to be a hard cap. It’s meant to be more of a checkpoint between the child and the physician. So, if the child is nearing the 75-hour limit, they need to go to their primary care physician and have the physician assess whether or not additional visits are warranted. And, if they are, if the physician believes the child is making great progress with this therapy and thinks additional therapy would be good for this child, he can recommend that. Then, we’ll review it. If it’s medically necessary, we’ll approve additional visits,” Stensland said.

“Part of the reason we’re doing this is we think it’s a good thing for the families and the primary care physicians to be having a dialogue as to whether a therapy is working. If it is, we’ll authorize more visits. If it’s not, we need to regroup or reassess what other kinds of treatment might be more effective.

He also said a federal rule for services referred to as Early and Periodic Screening, Diagnosis and Treatment (EPSDT) “basically … says if a therapy or treatment is medically necessary, then state agencies can’t put any cap on that.”

Dolnik also said federal regulations require approving therapy deemed medically necessary. She said such approvals are not happening.

“Every single child whose requests are being handed in are getting one hour of speech, one hour of occupational and one hour of physical therapy a week — every child, no matter what their pediatrician is saying is medically necessary.”

She said she learned last Monday of a process by which parents can appeal denied therapy hours for the children. But the deadline to file the appeal was Friday, she said, “so they’ve opened up a window of four days for parents to get all this information together and file an appeal.”